Prior Authorization

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Always check benefits through the voice response unit or My Insurance ManagerSM to determine if prior authorization is required.

Healthy Blue requires prior authorization for certain procedures and durable medical equipment. This process allows us to check ahead of time whether services meet criteria for coverage by a member’s health plan.

To search for authorization by code, use the Prior Authorization Lookup Tool below.

In many cases, approval is instant. When it’s not, we’ll review your request, considering:

  • Our medical policies.
  • Recognized clinical guidelines.
  • The terms of the member’s benefit plan.

Some requests may require additional documentation.

How to Request Prior Authorization

Medical and Behavioral Health Services

When you request prior authorization (PA) from us, we want the process to be fast, easy and accurate. We use the Cohere Health platform to provide you with a powerful tool to accelerate the PA process and expand real-time approvals.

You will still sign-on through My Insurance Manager so you can begin the process for medical services, but the portal will route you to the new web-based application, powered by Cohere Health, to enhance the efficiency of PA decisions.

Note: All clinical decisions are made by Healthy Blue.

Special Vendors

Cohere Health

Cohere Health is the new platform used to submit prior authorization requests.

Cohere Health offers prior authorization services on behalf of BlueChoice HealthPlan.

Evolent

Evolent is an independent company that manages the prior authorizations for radiology and high-tech imaging services on behalf of BlueChoice HealthPlan.

To request a prior authorization, you can:

Avalon Healthcare Solutions

Avalon is an independent company that manages the prior authorizations for laboratory services on behalf of BlueChoice HealthPlan.

Review the current Avalon list to see which codes require authorization.

To request a prior authorization, you can:

CarelonRx

CarelonRx is an independent company that manages the prior authorizations for certain medications on behalf of BlueChoice HealthPlan. 

To request a prior authorization, you can:

Retail

Home Delivery/Mail Order

Medical Injectables

Specialty Pharmacy

Prior Authorization Lookup Tool

Please verify benefit coverage prior to rendering services. Inpatient services and nonparticipating providers always require prior authorization (PA).

Please note:

  • Enter one CPT code at a time into the search.
  • This tool is for outpatient services only.
  • Inpatient services and nonparticipating providers always require PA.
  • This tool does not reflect benefits coverage nor does it include an exhaustive list of all noncovered services (that is, experimental procedures, cosmetic surgery, etc.). Refer to your provider manual for coverage/limitations.
  • For specialty pharmacy codes, visit the Pharmacy page and use the Medical Specialty Drug List Lookup Tool.
  • These codes are valid as of Oct. 10, 2025.

Disclaimer: Healthy Blue attempts to provide the most current information for the Prior Authorization Lookup Tool. Please note that this information may be subject to change, and a prior authorization is NOT a guarantee of payment. Reimbursement depends on a number of factors, including but not limited to member eligibility on the date of service, coverage limitations and exclusions, provider contracts, and correct coding and billing for the services at issue.